Provider Demographics
NPI:1013470582
Name:LEE, HESTIA YI
Entity type:Individual
Prefix:
First Name:HESTIA
Middle Name:YI
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CHONG ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1703
Mailing Address - Country:US
Mailing Address - Phone:808-315-8078
Mailing Address - Fax:808-315-8078
Practice Address - Street 1:151 CHONG ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1703
Practice Address - Country:US
Practice Address - Phone:808-315-8078
Practice Address - Fax:808-315-8078
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2-180055311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home